DIMAS ANDRE MILCHESKI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
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bookPart Reconstrução de membros inferiores(2015) MILCHESKI, Dimas André; NAKAMOTO, Hugo Alberto; MUNHOZ, Alexandre Mendonça- Estudo prospectivo da sensibilidade tátil em mãos de uma população brasileira usando pressure-specified sensory device(2012) TUSTUMI, Francisco; NAKAMOTO, Hugo Alberto; TUMA JUNIOR, Paulo; MILCHESKI, Dimas André; FERREIRA, Marcus CastroOBJECTIVE: To evaluate the pressure perception thresholds on the pulp of two fingers (index and little fingers), among a Brazilian population with no nerve injury or neuropathy. METHODS: We used the Pressure-Specified Sensory Device (a computerized device) to derive static and dynamic normal pressure perception thresholds and two-point discrimination distances. RESULTS: We tested finger sensitivity on 30 volunteers. Significance analyses were performed using the Student t test. The mean values (g/mm²) for static one and two-point pressure thresholds (s1PD, s2PD) and dynamic one and two-point discrimination (m1PD, m2PD) in the dominant index finger were: s1PD = 0.4, m1PD = 0.4, s2PD = 0.48, m2PD = 0.51. CONCLUSION: There was no significant difference in sensitivity between the dominant and nondominant hands.
- Sensory Testing in Patients With Hemodialysis-Associated Carpal Tunnel Syndrome Submitted to Surgical Decompression(2014) NAKAMOTO, Hugo Alberto; FERREIRA, Marcus Castro; TUSTUMI, Francisco; MILCHESKI, Dimas A.; TUMA, PauloBackground: Carpal tunnel syndrome (CTS) is the most common compression neuropathy of the upper limb. Close to 5% of patients with chronic renal failure who need hemodialysis present CTS. Clinical history and physical examination remain the most adequate tools for diagnosis, and there is still controversy regarding the most reliable test to complement it. Evaluation of sensory thresholds using Pressure-Specified Sensory Device (PSSD) has become an important instrumental test. Method: This study aimed to determine the values of pressure sensory thresholds using the PSSD before and after treatment of CTS in a special group of patients who underwent chronic hemodialysis. The PSSD incorporates a pressure transducer linked to a computer capable of measuring the cutaneous pressure thresholds referred by the patient. Two groups were compared as follows: group 1, patients with hemodialysis-related CTS; and group 2, CTS in nonYhemodialysis patients. The following measurements were assessed: static one point, moving one point, static two points, and moving two points. Results: There was improvement (lower thresholds) in the postoperative measurements in all parameters assessed in group 1, and improvements in all parameters except the moving one point test in group 2. Conclusions: Nerve decompression, as expected, can be considered a good treatment of CTS even in more severe cases as in those patients under hemodialysis. The PSSD tests were reliable to confirm the diagnosis and thus to indicate the decompression. It is even more beneficial to provide a comparison between preoperative and postoperative data and different causes of CTS.
- Terapia por pressão negativa na ferida traumática complexa do períneo(2013) MILCHESKI, Dimas André; ZAMPIERI, Felipe Muniz de Castro; NAKAMOTO, Hugo Alberto; TUMA JÚNIOR, Paulo; FERREIRA, Marcus CastroOBJECTIVE: To review the experience (2011 and 2012) of Wound Center of Plastic Surgery Service, Clinics Hospital, Faculty of Medicine, University of São Paulo, with treatment of complex traumatic wounds in the perineal region with the association of negative pressure wound therapy followed by a surgical skin coverage procedure. METHODS: This was retrospective analysis of ten patients with complex wound in the perineum resulting from trauma assisted by the Department of Plastic Surgery in HC-USP. Negative pressure was used as an alternative for improving local conditions, seeking definitive treatment with skin grafts or flaps. RESULTS: Negative pressure was used to prepare the wound bed. In patients, the mean time of use of negative pressure system was 25.9 days, with dressing changes every 4.6 days. After negative pressure therapy, 11 local flaps were performed in nine patients, with fasciocutaneous anterolateral thigh flap used in four of these. Mean hospital stay was 58.2 days and accompaniment in Plastic Surgery was 40.5 days. CONCLUSION: The use of negative pressure therapy led to improvement of local wound conditions faster than traditional dressings, without significant complications, proving to be the current best alternative as an adjunct for the treatment of this type of injury, always followed by surgical reconstruction with grafts and flaps.
- Uso da terapia por pressão subatmosférica em feridas traumáticas agudas(2013) MILCHESKI, Dimas André; FERREIRA, Marcus Castro; NAKAMOTO, Hugo Alberto; PEREIRA, Diego Daniel; BATISTA, Bernardo Nogueira; TUMA JR, PauloOBJECTIVE: To evaluate the use of subatmospheric pressure therapy in the treatment of acute traumatic injuries of the soft tissues, especially in the limbs. METHODS: One hundred and seventy-eight patients with traumatic wounds were treated by the Center for Complex Wounds in the period from January 2010 to December 2011, and submitted to subatmospheric pressure therapy (SPT). RESULTS: Of the 178 patients who underwent SPT, 129 (72.5%) were male and 49 (27.5%) were aged between 18 and 40 years. Degloving injuries to the limbs were the most common type of traumatic wounds, being responsible for the hospitalization of 83 (46.6%) patients. Mean hospital stay was 17.5 days. A total of 509 procedures were performed (average 2.9 per patient). SPT was used in 287procedures, 209 (72.8%) on traumatic wounds and 78 (27.2%) of skin grafts. The number of exchanges of the SPT apparel per patient was 1.6 and the mean time of use, 8.5 days. CONCLUSION: SPT significantly reduced morbidity and healing time of injuries when compared with previously performed dressing treatments. The subatmospheric pressure therapy is a useful method in treating acute traumatic wounds, acting as a bridge between the emergency treatment and the final coverage of the skin lesions, being better when compared with more traditional methods of plastic surgery.
- Desenvolvimento de modelo experimental de avulsão de retalhos em membros inferiores de ratos(2012) MILCHESKI, Dimas André; FERREIRA, Marcus Castro; NAKAMOTO, Hugo Alberto; TUMA JR, PauloBACKGROUND: The purpose of this study was to develop an experimental model for degloving injuries of the hind limbs of rats and observe flap viability after its relocation to the wound bed to better study the changes related to the injury and to test the therapeutic modalities in avulsed flaps. METHODS: Ninety male Wistar rats were divided into 4 experimental groups. A flap avulsion model on the lower limb of a rats was established, using 4 different pedicles: proximal flow pedicled flap (G1), distal flow pedicled flap (G2), lateral flow pedicled flap (G3), and medial flow pedicled flap (G4). RESULTS: Comparison between the mean necrotic area of the degloved flap showed statistically significant differences among the 4 groups (P < 0.0001). CONCLUSIONS: The group with the distal flow pedicled flap (G2) showed a higher necrotic area relative to the total flap area and it is the most suitable group for testing therapeutic agents in avulsed flaps.
article 1 Citação(ões) na Scopus AVALIAÇÃO DA SENSIBILIDADE CUTÂNEA EM PACIENTES COM SÍNDROME DO TÚNEL DO CARPO RELACIONADA À HEMODIÁLISE(2011) NAKAMOTO, Hugo Alberto; TUMA JUNIOR, Paulo; MILCHESKI, Dimas Andre; FERREIRA, Marcus CastroObjective: The aim of this study is to describe the use of the PSSD (Pressure specified sensory Device) for the diagnosis of carpal tunnel syndrome. Methods: The PSSD is a tool that incorporates a pressure transducer with two prongs, linked to a computer capable of measuring the cutaneous pressure thresholds. The patients were divided in two groups: Group 1- patients neither with superior limb neuropathy nor renal insufficiency. Group 2- patients with carpal tunnel syndrome related to hemodialysis. Group 2 - patients with carpal tunnel syndrome but no renal insufficiency. Results: The results showed, for two of the four parameters measured, that the group 2 had more benefits for the diagnosis of carpal tunnel syndrome than group 3. Conclusion: The PSSD is useful as a diagnostic tool in hemodialysis-related carpal tunnel syndrome Level of Evidence: Level II, development of diagnostic.